| NPI | 1225436553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A167065) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: OK 33005) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2020-05-27 |